Wilderns Drug Store

Primary specialty

PharmacyTaxonomy code 333600000X

License

5301004387 Issued in MI

Legal business name

WILDERNS DRUG STORE

Practice address

123 Lansing Road
Potterville, MI 48876

Phone

(517) 645-7680

Fax

(517) 645-7698

NPI assigned

Feb 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jeffrey Alan Wildern, RPH

Title

President

Phone

(517) 645-7680

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Wilderns Drug Store2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wilderns Drug Store

  • Durable Medical Equipment & Medical Supplies
  • Charlotte, MI
  • NPI 1568435873
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Debora Jo Crowley, B.S.

  • Pharmacist
  • Potterville, MI
  • NPI 1093903247
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881669745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 LANSING ROAD",
            "address_2": "WILDERNS DRUG STORE #2",
            "city": "POTTERVILLE",
            "state": "MI",
            "postal_code": "48876",
            "telephone_number": "517-645-7680",
            "fax_number": "517-645-7698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 LANSING ROAD",
            "city": "POTTERVILLE",
            "state": "MI",
            "postal_code": "48876",
            "telephone_number": "517-645-7680",
            "fax_number": "517-645-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERNS DRUG STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILDERN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "517-645-7680",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301004387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "2340444",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2340444",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Ann Rosenbrook, LPC
• Vicki Roush, MA, LLP, LLPC
• Angela Schmalbach, RN
• Jill Christine Sidange, PMHNP-BC
• Thomas a. Sainz D.O., P.C

• Pharmacy in Potterville, MI
• Providers in Potterville, MI by specialty
• Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.